The objectives of this proposal are to assess the effects of hospital closures on the access to hospital care, patterns of care, and cost and outcomes of care for Medicare beneficiaries with multiple ADM disorders living in areas where hospitals have closed since 1984. We will use a longitudinal study design, with a matched control group, to compare our findings for Medicare populations living in similar geographic areas where hospitals remained open. Findings will be reported separately for rural and urban areas, to determine if the effects of hospital closures differ among rural and urban populations. This proposal uses a relatively strong study design, and a unique approach which incorporates recent work on risk adjustment along with techniques of Small Area Analyses to assess changes in access to care, costs, and outcomes of care. Our measures of access, outcomes and costs for the Medicare populations living in closure and non-closure areas will include: comparisons of hospitalization rates, lengths of stay, cost of care, rate of discharge to other hospital (instead of to home), and the total costs of care received in the six months period following the index admission. A measure of outcome of care within six months of admission: Risk-adjusted readmission rates is also used.